Healthcare Provider Details

I. General information

NPI: 1669384822
Provider Name (Legal Business Name): MR. JONATHAN MYERS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 AUSTIN GRAYBILL RD
NORTH AUGUSTA SC
29860-9251
US

IV. Provider business mailing address

500 GEORGIA AVE
NEW ELLENTON SC
29809-2719
US

V. Phone/Fax

Practice location:
  • Phone: 803-278-4272
  • Fax:
Mailing address:
  • Phone: 803-646-2812
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number32629
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: